Review of the Annual Review of Competency Progression (ARCP)

Medical education reform NHS Workforce Strategy, Facing the Facts, Shaping the Future HEE will contribute to high quality patient care by enhancing the delivery of medical training. We will ensure doctors are supported, valued and enabled to be highly effective clinicians, facilitating better integration with multi-disciplinary teams and their development, and with the wider professions to deliver an effective and sustainable workforce.

ARCP Engagement Task and finish groups and wider stakeholder group to co-design recommendations Call for evidence throughout August 2017 Over 680 responses including from trainees, registrars, consultants, as well as organisational responses, including GMC, BMA and Royal Colleges. Majority of responses directly from trainees. Trainee and trainer recommendations ‘testing groups’ Appraisal & Assessment Recommendations Individualised Training Pathways Recommendations Wider workforce proposals development session Patient & Public Voice - Lay representation group Insight into role of ARCP panel and lay representation on it Testing confidence and consistency of ARCP process What we’ve heard continually fed back into emerging recommendations

What we heard – key themes Majority of respondents said they are not confident in current ARCP process. Numerous references to being a ‘tick box’ exercise; ‘form filling’ and ‘jumping through hoops’.  The ARCP overall was an impersonal experience with no acknowledgement of excellence References to system time constraints, educational supervisors time with trainees; trainees time to complete the e-portfolio/ work based assessments.  General picture of need for clarity of what the ARCP was, what the expectations of trainees and educational supervisors should be within the process and what was a good outcome.

What we heard – key themes Suggestion of potential conflict of interest - ES wouldn’t want to fail trainees as it would reflect poorly on the ES, or create too much work. General consensus that further training/support should be given for ES, with a clearer set of expectations communicated to both trainees and ES on responsibilities. It was suggested that better use of the e-portfolio would allow doctors out of training to evidence their work. Wider points were raised around allowing doctors outside of training to access the curriculum

Draft Recommendations – Clarifying ARCP purpose The purpose of the ARCP, should be more effectively communicated across the system to ensure a shared understanding and to clarify the steps involved in the annual progression and training cycle, including its purpose in ensuring trainees fulfil GMC revalidation requirements. Recommendation 2 The expectations and responsibilities of those involved in ARCP processes should be more explicitly defined and communicated, including those of trainees, the ARCP panel and panel members, educational supervisors and wider stakeholders. This includes being clear of the required competencies at the start of the training year. Recommendation 3 HEE should coordinate and implement a system wide communication strategy, which will aid the implementation of all the recommendations identified through the Review. This should aim to set out the expectations of the system, and empower trainees to ensure they are aware of their responsibilities.

Draft Recommendations – Educational Supervision Formative mid-year feedback and other timely feedback, such as pre-ARCP meetings to support trainees in preparing for ARCPs should be standard practice. This will ensure there are no surprises, that career discussions can take place at appropriate points, and to identify and appropriately support trainees who are not progressing. Recommendation 5 The quality of Educational Supervision is paramount across the ARCP cycle, therefore, educational supervisors should be appropriately supported and trained. This should include ongoing faculty development and crucially, the appropriate allocation of time in their jobs plans to develop and deliver the full aspects of their role. Recommendation 6 The consistency of Educational Supervisor reports and trainee feedback should be enhanced by providing guidance on good practice, format and areas that should be included. This will be developed with and for trainees.

Draft Recommendations – ARCP Panels Formative feedback is crucial to empower trainees in their progression. As per the Gold Guide, ARCP panels should be held in absentia*. Therefore, post-ARCP feedback should be offered to all trainees, including ‘stretching’ feedback to recognise the achievements of and further propel those performing well and identify areas for further development.   Recommendation 8 Training and national guidance should be provided to ARCP panels to aid high quality and consistent decision making. As a minimum, this should include training for Equality and Diversity, high quality feedback provision, and decision-aids that are applicable nationally and are consistent in quality across specialties. *technology may enable virtual panels in the future

Draft Recommendations – Support for trainees Educational Supervisors, ARCP Panels and trainees should be provided with high quality information about the professional and personal support available to all trainees, particularly those receiving unexpected and unsatisfactory outcomes. Educational and Clinical Supervisors should also be able to identify trainees in difficulty at the earliest possible opportunity, to ensure a ‘no surprises’ culture at ARCP.

Draft Recommendations - QA Standardised quality assurance and quality management across ARCP processes is required to ensure high quality of educational supervision, high quality work-based assessment and consistency of ARCP decisions, outcomes and appeals. HEE and the Royal Colleges should work together to leverage existing mechanisms to ensure this, such as the HEE Quality Framework, and current review processes in some Colleges to hold to account the system for delivery. The Royal Colleges should explore how cross specialty intercollegiate learning can support this process.

Next steps… Report to be published Spring 2018 Continued work with our partners on implementation of agreed recommendations.

Discussion Opportunities/benefits of the recommendations Challenges/barriers of delivering them Role of NACT and others

The “Blue Triangle” CCT Holders – consultants and GPs Career Grade Doctors Training Grades ACPs and the wider workforce The ARCP review and blue triangle allows an opportunity to: Define competence Enable progression Use the full capabilities of healthcare professionals Unlock barriers between grades Support multi-disciplinary teaching, training and working To improve patient care and ensure a flexible and adaptable workforce to meet future patient and service needs. Establish the mix and numbers of workforce posts capable of delivering the volume of services to the standards required, informed by local workforce plans. Facilitate the development of common competencies and expectations of roles, supporting assessment and career progression, enabling planned rather than reactive workforce planning. Respond to workforce challenges in service and workforce transformation initiatives by focusing on the role of multi-disciplinary teams, across professional and organisational boundaries, to put the patient at the heart of health and care.

Appraisal and Assessment Principles Healthcare professionals developing competence or scope of practice should do so within framework of an agreed curriculum that sets out the knowledge, skills, values and behaviours required, and specify appraisal and assessment requirements. Learners should have access to a portfolio that enables collection and presentation of evidence to demonstrates competency progression. Learners should be supported by trained supervisors and/or mentors with available time, resources and access to professional support. There should be a widely recognised, valid and reliable assessment process to review progression against the curriculum that provides a consistent standard to protect patient safety and support transferability of competences. Once a defined level of competence has been achieved this should be documented within a register recognised by learners, faculty, employers and the wider public.